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HEALTH Insurance
HEALTH INSURANCE INSIGHTS

Health insurance can be pricey, but you may still find affordable health insurance that works for you. 

Affordable Health Insurance

Health insurance can be expensive, but you may still find affordable health insurance suitable for you.

You are likely limited to one or two health insurance choices if you’re covered through an employer. If your spouse is also eligible through an employer, that may add one or two alternatives.

You may have more choices if you shop for a health plan outside of employer-sponsored options, such as individual health insurance. However, that can also mean higher costs since you won't have an employer helping pay for health insurance.

Here is a look at how to shop for cheap health insurance.

Affordable health insurance in employer plans

Most working-age Americans get their health insurance through an employer.

A benefit of employer-sponsored health insurance is that your job helps pay for coverage. Kaiser Family Foundation estimates employers, on average, pay 83% of health insurance costs in a single plan, and the employee picks up 17%. On average, employers pay 73% of health plan costs in a family plan and employees absorb 27%.

The downside of employer-sponsored plans is that you're limited to what your job offers and may only give you one option. Businesses increasingly look for ways to cut healthcare costs and one way is to limit health insurance to a single, high-deductible health plan.

High-deductible health plans (HDHPs) have a deductible of at least $1,400 for individuals and $2,800 for families.

A deductible is the amount you pay for eligible healthcare services or medications before your insurance plan begins to share the cost.  Once you reach your deductible limit, the health plan begins to pay for healthcare after you pay for your coinsurance amount.

HDHPs are often the cheapest employer-sponsored health insurance plans in terms of premiums, but significant deductibles and out-of-pocket costs can offset low premiums if you need healthcare services.

How to find an affordable plan:

  • Check with your employer and spouse's employer to review health insurance offerings. You can sign up or make changes to your health insurance during open enrollment, or in case of an approved change in life circumstances. Open enrollment varies by employer.
  • You may want to consider a health maintenance organization (HMO) plan rather than a preferred provider organization (PPO) plan for a more affordable option. HMOs have lower premiums than PPOs and similar deductibles. One downside of HMOs is that they have restricted provider networks, so you can only see providers in that network. Plus, you must get referrals from your primary care provider to see specialists. However, that trade-off means you may pay half the premiums found in PPOs.
  • An HDHP could be a wise choice if you don't expect to need much healthcare over the next year. HDHPs have lower premiums but higher out-of-pocket costs than HMOs and PPOs. HDHPs also may have health savings accounts that let you save tax-free money for your healthcare. Find out more about the differences between health plans.
  • Check each plan's premiums, copays, deductibles and coinsurance, which is the percentage you'll pay for healthcare services once you reach your deductible. Those numbers give you an idea of which plan is most affordable for you.

Individual and Affordable Care Act (ACA) plans

Expert Advice
Kevin Griffith
Kevin Griffith
Assistant Professor, Department of Health Policy, Vanderbilt University, Nashville, TN

“Many uninsured individuals are eligible for generous subsidies, but either don't realize it or do not take advantage of them.”

Individual health plans are available in the ACA marketplace and outside the marketplace.

The ACA created exchanges to compare and purchase an individual health plan. The plans on the exchanges must meet specified criteria, such as covering ten essential health benefits, including prescription drugs, outpatient, hospitalization, and mental health.

The federal government also offers tax credits and subsidies for people who qualify based on their income as part of an ACA plan. Suppose your household income is between 100-400% of the federal poverty level, you are likely eligible for subsidies to reduce an ACA plan's cost. That’s about $12,880 to $51,520 for an individual and $26,500 to $106,000 for a family of four.

According to Dr. Kevin Griffith, an assistant professor at Vanderbilt University's Department of Health Policy, people too often fail to take advantage of this kind of government assistance. He notes that "Many uninsured individuals are eligible for generous subsidies, but either don't realize it or do not take advantage of them."

You'll be asked to submit your household income information when shopping on the ACA exchanges’ website. The tool provides options that consider subsidies, so you you’ll know what to expect to pay in premiums.

The ACA marketplace classifies plans by metal tiers:

  • Bronze
  • Silver
  • Gold
  • Platinum

The most affordable health insurance in the ACA marketplace in terms of premiums are Bronze plans.

These have the lowest premiums but the highest deductibles and out-of-pocket costs. A Bronze plan generally costs less initially but requires more in out-of-pocket expenses than the other plans for healthcare services.

Platinum plans have the highest premiums but the lowest out-of-pocket costs and deductibles.

Silver plans typically have higher premiums than Bronze. However, if you qualify for subsidies, you may find a Silver plan that's actually cheaper than a Bronze plan. A Silver plan has lower out-of-pocket costs than Bronze. So, if you qualify for subsidies, a Silver plan might be a better bet than a Bronze plan.

However, if you don't qualify for subsidies, ACA plans can be more expensive than an employer-sponsored plan. In that case, you may want to look for an individual plan outside of the marketplace. Plans outside of the exchanges don't include as many requirements and can be more affordable than ACA plans.

You can look for an individual plan outside of the exchanges by checking with an independent health insurance broker or going directly to area health insurers.

If you shop for a plan outside of the exchanges, check its coverage, so you know what to expect before signing up.

How to find an affordable plan: 

  • Visit healthcare.gov, which is the ACA exchange’s website. The site asks you to enter information such as where you live and your family income. With that information, the tool provides health plan options and premium estimates.
  • Choose an HMO over a PPO. HMOs are cheaper but offer the same coverage. HMOs, however, require referrals to see specialists and you're only able to see doctors in the HMO's network.
  • A Bronze plan can be the better choice if you don't expect to need to see a doctor often over the next year.
  • If you qualify for subsidies, a Silver plan can wind up costing as little as a Bronze plan, but has lower out-of-pocket costs.
  • If you can't find an affordable plan on the exchanges, check with individual health insurers in your area for options outside of the exchanges.

Medicaid

Medicaid is a low-cost health insurance plan with the same benefits as an employer-sponsored health plan.

Depending on your income, you pay little to nothing for Medicaid if you're eligible. The combination of low costs and comprehensive benefits make Medicaid an excellent, affordable health insurance choice for those who qualify.

Medicaid premiums are based on income, which varies by state. Thirty-eight states expanded Medicaid eligibility to up to 138% of the federal poverty level. That's $17,609 for an individual and $36,156 for a family of four. The other 12 states have stricter eligibility guidelines.

One drawback is that not all providers accept Medicaid, so you may encounter issues finding a doctor that accepts Medicaid.

How to find an affordable plan: 

  • Check with your state's Medicaid program. The state program can figure out whether you're eligible and provide options.
  • States usually don't offer a choice for Medicaid. Instead, you enroll in the state Medicaid program or a managed Medicaid plan, which is a private insurer that contracts with the state.

Catastrophic health plans

Catastrophic health insurance offers low-cost premiums with the comprehensive coverage found in standard health insurance. Catastrophic plans cover preventive care, pregnancy, mental health, prescription drug, rehab, labs, outpatient and inpatient care. These plans are limited to people under 30 or those who are facing specific hardships such as homelessness.

Catastrophic plans are available through the Affordable Care Act marketplace. The plans have low premiums, but high deductibles. The average monthly premium is only $195, which is much cheaper than other plans.

However, the deductible is around $8,000. You have to pay for healthcare services until you reach your deductible, at which point the plan then pays for all your healthcare costs. Catastrophic health insurance doesn't have a coinsurance portion, which is different from many other plans.

How to find an affordable plan:

  • Visit your state's ACA marketplace. If you're under 30, catastrophic health insurance should  appear as an option.
  • If you're facing a hardship, contact your state's marketplace directly and provide information.

Short-term health plans

Another low-cost option for most Americans is a short-term health plan. You can likely find a short-term health plan for much lower premiums than an employer-sponsored or individual health plan.

Griffith cautions that you should look beyond price before choosing this kind of plan: "Short-term plans generally cost less than traditional insurance plans, but they are exempt from many of the ACA's consumer protections. Unlike traditional insurance plans, short-term plans do not need to cover pre-existing conditions, essential health benefits, and may have lifetime and annual benefit limits."

However, these plans aren't technically considered health insurance. They provide coverage for a short period and don't have the same level of benefits you usually find in a health insurance plan.

For instance, short-term health plans usually don't cover maternity, prescription drugs and mental healthcare. They also have annual coverage caps and you have to pay all of the costs once you reach it.

Short-term health plans are available for one year and most states let you renew them twice. California, Hawaii, Massachusetts, New Jersey and New York don't allow short-term plans. Colorado, Delaware, the District of Columbia, Illinois, Maryland, New Mexico, Vermont and Washington limit the plan's length.

Short-term health plans can help you in between jobs or until a new employer starts covering you. These plans aren't meant as long-term health coverage.

How to find an affordable plan: 

  • A Google search provides you with insurers that offer short-term health plans.
  • Pore over the fine print to understand what the plan covers and what it doesn't.

How do I get cheap health insurance?

Regardless of how you shop for an affordable health insurance plan, you'll want to examine the numbers and make sure your doctors accept the plan. Otherwise, you may have to pay more or all of the costs for visits to those doctors.

Compare the premiums, copays, deductibles and out-of-pocket costs. Also, determine what costs are most important. Finally, ask yourself, “Would I rather lower premiums or lower out-of-pocket costs?”

Michael Daugherty, vice president of sales at GetInsured, advises that very low-premium plans can have higher price tags because of out-of-pocket costs.

"Purchasing a plan with a low premium can be a pitfall if it ends up having a high deductible,” he says. “Also, short-term plans may appear to be cheap, but they only cover you in a catastrophic situation and generally exclude expenses that may result from pre-existing conditions. It's important to buy health insurance from a reputable, qualified broker who can explain your options and tell you what the real cost of a health insurance plan is."

Deborah Gordon, author of "The Healthcare Consumer's Manifesto: How to Get the Most for Your Money," says the best plan depends on your specific circumstances.

"If you don't expect to need a lot of healthcare services, that trade-off may work out well for you,” Gordon explains “But, if you're worried about unanticipated expenses or wouldn't be able to handle medical bills, consider a plan that protects you a little better."

Andrew Roderick, CEO at Credit Repair Companies, maintains that researching your options and figuring out what you want from a health plan is key.